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Alasdair Neil Warwick, Hannah Leaver, Andrew J Lotery, Srini Goverdhan; Visual and anatomical outcomes of a fixed dosing and reduced monitoring aflibercept treatment regimen in neovascular age-related macular degeneration patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5352.
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Neovascular age-related macular degeneration (AMD) responds to anti-vascular endothelial growth factor treatments with aflibercept and ranibizumab. However, real life clinical outcomes using trial regimens are lacking. We performed a retrospective, observational study on outcomes for a fixed dosing aflibercept treatment regimen with reduced monitoring.
165 neovascular AMD patients (male:female = 64:101) treated with aflibercept were identified. Mean age was 81.6 years (range 60-96). These patients had either switched from previous treatment with a pro re nata (PRN) ranibizumab regimen (n=107) or were treatment naïve (n=58). A fixed dosing and reduced monitoring regimen of aflibercept was used, as outlined in figure 1. Choroidal neovascularisation (CNV) subtypes, best-corrected visual acuity (BCVA), central retinal thickness (CRT) and number of injections/clinic visits over 13 months were analysed. Wilcoxon matched-pairs signed rank test was used to compare BCVA and CRT at last follow-up to baseline.
12% of patients had predominantly/minimally classic CNV (>60% patients in VIEW 1 study), while 88% had occult type CNV lesions. Mean BCVA change at month 13 was +3.28 and +4.67 letters in the switched and naïve aflibercept groups respectively (p<0.01). BCVA stabilised or improved in 85% of switched and 86% of naïve patients (table 1). CRT at month 13 showed a mean decrease of -6.16µm in the switched group and -35.36µm decrease in the naïve group (p<0.01). Mean follow-up for patients previously treated with ranibizumab was 12.6 months, receiving an average of 7.39 ranibizumab injections and attending 10 clinic visits. Treatment with the fixed dosing aflibercept regimen required 7 injections and 3 clinic visits per year.
Aflibercept is effective in both treatment naïve neovascular AMD patients and those resistant to previous ranibizumab treatment. Furthermore, adopting a fixed dosing regimen with reduced monitoring required considerably fewer clinic appointments than PRN dosing, saving valuable healthcare resources.
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